On May 28th, we celebrate Menstrual Hygiene Day, a chance to spotlight a normal biological process rendered a problem for far too many. Because menstruation is met with a mandate of shame, silence and secrecy, many menstruators lack the information and support they need to care for their bodies with confidence and ease, but hopeful change is underfoot.
By Chris Bobel
The (Red) Tide is Turning….
Over the last few years, this natural embodied reality has captured unprecedented attention in a variety of settings from media coverage to programmatic and policy interventions. Consider the box office success of “Pad Man,” a 2018 Indian biopic about the man who invented a low cost menstrual pad-making machine and legislative efforts to provide free commercial menstruation products to school girls in the US, South Africa, Kenya, Uganda and the UK. And during the UN’s Commission on the Status of Women in March, the “Agreed Conclusions” explicitly asserted the necessity of UN member states to “take steps to promote educational and health practices to foster a culture in which menstruation is recognized as healthy and natural and in which girls are not stigmatized on this basis.”
But What Does the Research Say?
These watershed moments are thrilling. The menstrual cycle, after all, directly impacts half the world’s people, so the way we address it matters! That’s why I feel the need to pause, assess our priorities and consider the available research. Many programs are founded on the assumption that getting girls menstrual products to replace the traditional methods they typically use (most often cloth) will keep them in school despite an immature evidence base to validate this claim. Some rigorous trials are underway and may illuminate a way forward. To date however, there are only a handful of studies that show a causal relationship between product provision and school attendance, such as this cluster quasi-randomized controlled trial in rural Uganda that suggests that providing reusable sanitary pads or puberty education may improve girls’ school attendance. But meta-analysis of the extant research reveals that knowledge gaps exist. For example, one systematic review concluded that there is insufficient evidence to establish the effectiveness of menstruation management interventions such as product provision. Another review of research in the Indian context showed a relationship between school attendance and access to menstrual pads but when the analysis was adjusted for region, the relationship was not significant. However, many studies point to the psychosocial factors that trouble girls’ menstrual experiences, such as this one where girls reported their embarrassment and of fear of teasing, as well as pain and lack of effective materials, led to school absenteeism.
Nonetheless, organizations are working hard to make menstrual products more effective, affordable, and accessible. In the West, startups are promoting high tech, super absorbent menstrual panties, smart tampons and apps that track your cycle so that you don’t have to. While a wider field of options to care for menstruating bodies is a boon, especially in regions where resources are limited, many of these innovations fall into the category of what’s called “technological fixes”—simple solutions that fail to meet the complexity of the very problem they aim to solve and often introduce new problems into the mix, such as stressing already-overburdened waste management systems with discarded products.
So Why the Gravitational Pull Toward Products?
Products are simple, tangible, and relatable and they speak the language of menstruation, one dominated by the vocabulary of capitalism. That is, when we talk about menstruation, we typically limit our discussions to what we use to clean it up, rather than seeing menstruation as part of a systemic, ongoing menstrual cycle that lasts, on average, 40 years and a 5th vital sign, alongside blood pressure, temperature, pulse and respiration rate.
I want to be clear that I am not romanticizing traditional methods—some menstruators certainly clamor for—and deserve—materials that work better in their particular contexts. And no doubt, bringing attention to menstrual materials is a way to force a discussion that has historically been silenced. Sure enough, products can serve as a foot in the door. But I am concerned about what happens once we get inside the door. When we focus on products, we often (and perhaps ironically) lose sight of stigma. Menstrual products after all, are tools, what Sharra Vostral calls “technologies of passing” that work to hide evidence of menstruation at the same time they meet a real need. Our current product obsession can eclipse the sociocultural dimensions of menstruation, namely the damaging effects of the assumption that menstruation is disgusting and a source of shame. If we are going to really leverage recent interest in menstruation, we must be mindful that menstruators need more than something to bleed on, they also need information and support.
While it is true that many organizations are pairing products with education (and some do policy work and infrastructural work, too), my own (forthcoming) research reveals that educational programming is often very limited and an adjunct to product manufacture and/or distribution. Programs are typically directed only at girls, limited to a one-off event, and often led by educators who are inadequately trained and supported to handle the sensitive topics that discussion of menstruation inevitably stirs up (sexuality, consent, dating violence, and more). In short, there is lots of room for improvement in this area, and yet, I think it is the most important work we can do. Because, at the end of the day, cups, pads, tampons, panties and whatever innovation is in beta testing as I write, are still just tools that serve to keep menstruation hidden. Even in an ideal world where every menstruator has unrestricted access to products, menstrual stigma still lurks, ready to pounce at the moment of that inevitable leak.
A Challenge to Funders: Priotize the Fight to End Menstrual Stigma through Education
In the menstrual health sub-sector, we typically think of innovation only when we consider menstrual technologies. What if we redoubled our efforts to innovate ways of resisting stigma by normalizing the menstrual cycle? If menstrual champions can recalibrate and channel more resources to develop educational interventions, we will slowly erode the stigma that makes menstruation a burden. There are some good models. Consider this health magazine for Kenyan girls as well as these puberty health books for both boys and girls in a number of countries. This UNICEF-led program underway in Indonesia is especially important because it motivates boys to shift from being bullies to being allies. How can we harness our creativity to do more? To engage teachers? Parents? Religious leaders? How can we capture and sustain the attention of everyone in a girls’ orbit to build a durable web of support?
Do we need materials to help us care for our menstruating bodies? Of course, we do, but this focus cannot overshadow the deeper need for stigma busting through education. When funders consider underwriting a pad giveaway scheme or the establishment of a pad-making micro business, why not insist on high quality educational initiatives alongside this work and provide the resources to make it happen? If the tremendous energy going on in this space were re-directed toward developing high impact creative, interactive, and culturally-responsive curricula and pedagogies, we could truly change the conversation, and thus, the experience.
This burgeoning menstrual movement is at a crossroads. Will it reduce menstruation to a mess to be tidied away, or will it seize this chance to reframe the menstrual cycle as a vital marker of health and promote the teaching of menstrual literacy to promote well-being, self-awareness and gender equality?
It is up to us. We can choose to cede the movement to the product makers, or we can work toward substantive social change that will make menstrual stigma history.
Chris Bobel is Associate Professor of Women’s, Gender and Sexuality Studies at the University of Massachusetts Boston and past president of the Society for Menstrual Cycle Research. Her other books include New Blood: Third Wave Feminism and the Politics of Menstruation and Embodied Resistance: Challenging the Norms, Breaking the Rules.